Further studies on the treatment of ocular onchocerciasis with diethylcarbamazine and suramin.

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Abstract
Whether or not the elimination of microfilariae by diethylcarbamazine citrate (DEC) would reduce the side effects of a subsequent course of suramin and make it more acceptable and safer in the treatment of onchocerciasis was examined. Heavily infected patients [54] with ocular onchocerciasis were treated with an initial 2-wk course of DEC, in which the dose was increased slowly from 25 mg on the 1st day to 150-200 mg twice daily on days 8-14. Betamethasone 1.5 mg was given twice daily 2 days before DEC administration, and during the days of increasing DEC dosage, after which it was tailed off. This course was followed by 3-5 weekly injections of suramin. It was possible to rid these heavily infected patients of most of their microfilariae during the initial course without intolerable side effects. The subsequent suramin course was in general well accepted except in 1 case, where there was a serious aggravation of anterior uveitis. The later development of retinal pigment atrophy in 3 patients, of optic atrophy in 3 others, and of retinal and optic atrophy in 1 patient is discussed. The effects of this regimen on eye lesions and visual acuity at the final examinations (1-4 yr) compared favorably with those from a previous trial of suramin given alone or followed by DEC.